Management and Leadership Best Practices Award, sponsored by Apotex Inc.

Background

Prior to restructuring, the Winnipeg Regional Health Authority’s Pharmacy Program (WRHAPP) coordinated the delivery of pharmacy services at eight facilities with different drug distribution systems and pharmacy practice models. Pharmacy Managers had matrix accountability to their site and the WRHAPP.

Objectives

A three year pharmacy change initiative was approved, with the objectives of: i) creating a single line of staff accountability to the WRHAPP, ii) expanding, and standardizing the use of information/automation technologies, iii) focusing pharmacists on direct patient care activities, iv) expanding the role of pharmacy technicians to encompass responsibility for most drug distribution activities, v) creating management positions for pharmacy technicians, and vi) developing regional teams of specialized pharmacists, aligned with the WRHA’s clinical program model.

Methods

Changes in the roles of pharmacists, technicians, and automation technology were facilitated by: i) the use of a structured project management approach, ii) the development and delivery of targeted educational/training programs, and iii) a consistent, repetitive communication strategy

Conclusions

The new model optimizes the use of pharmacy staff and automation technologies and positions the WRHAPP to efficiently deliver high quality, patient-focused pharmacy services.

Background

Research is critical for the future of pharmacy yet institutional pharmacists’ current research activities and perceptions towards research are largely unknown.

Objectives

To describe institutional pharmacists’ involvement in research activities and to assess the attitudes of pharmacists towards research.

Methods

We conducted a cross-sectional survey of all institutional pharmacists within Alberta Health Services, Alberta, Canada, in March 2011. The survey explored involvement in research, current research activities, and attitudes towards research.

Results

Overall response rate was 45% (286/636). Respondents were predominantly female (80%), practiced in urban institutions (76%) and reported a primary clinical role (61%). Over half of pharmacists indicated having involvement in research (168/286 [60%]) with 43% of pharmacists (119/280) currently participating in research activities but only 26% (72/280) leading research projects. Pharmacists tended to agree (94%) that research was important to the profession of pharmacy. Almost all respondents (99%) felt that pharmacists should be involved in research, but indicated additional time and training were barriers to their personal involvement.

Conclusion

While the majority of institutional pharmacists in Alberta have had involvement in research projects, few were involved in leading research. There is strong support from pharmacists to be involved in research.

Patient Care Enhancement Award, sponsored by AstraZeneca Canada Inc.

Background

A 2009 survey found >25% of Canadian family medicine residency programs have a pharmacist teaching residents; however, little is known about the impact of these pharmacists.

Objective

Evaluate the role of pharmacist teachers within Canadian family medicine residency programs.

Methods

One-on-one interviews with residents, physicians and pharmacists from the 40 Canadian family medicine residency programs that employ a pharmacist teacher. Interviews continued until data saturation was observed. Transcripts were analyzed using grounded theory analysis (inductive and deductive) to identify themes. Codes were entered into NVivo software. Themes were sent to participants to confirm validity.

Objectives

To develop and implement a pediatric AP combined with a prescription based on validated pictograms accessible to the patient, pharmacist and physician.

Methods

The Asthma Action Plan and Prescription (AAPP) was developed by a working group from ED, Respirology and Pharmacy, with additional input from the Ontario College of Pharmacists and the Institute for Safe Medication Practices. Evidence-based content was enhanced with pictograms of asthma control/triggers, with prescriptions embedded. Education was sent to ED staff via emails, posters and educational sessions. The ED pharmacist, via the region’s pharmacy email system/website and telephone, instructed retail pharmacies how to incorporate the AAPP into practice.

Results

Since implementation in March 2011, more than 750 AAPPs have been used. Response is positive based on physician, pharmacist and patient feedback. An analysis of effectiveness is planned.

Conclusions

An AAPP has been developed and implemented to enhance patient, pharmacist and physician asthma management. The AAPP facilitates physician use of the document and subsequent enhanced rational medication prescribing.

Pharmacotherapy Best Practices Award, sponsored by Merck Canada Inc.

Background

Capecitabine is an oral pro-drug of the cytotoxic agent 5-fluorouracil used in the treatment of several types of cancer. As more oral chemotherapy agents come to market, there is interest in how pharmacists in oncology can adapt their practices to best provide patient care.

Objective

To establish and evaluate the impact of a pharmacist-led toxicity management program for patients being treated with capecitabine.

Methods

Implementation and prospective evaluation of the program was conducted using a matched historical cohort. Pharmacists performed weekly toxicity assessments. Interventions were made using developed algorithms and evidence-informed guidelines. Patient quality of life and satisfaction with the program were also evaluated.

Results

Seventeen patients were enrolled with 17 retrospective matches subsequently identified. There was a trend towards a decreased requirement for dose modifications and a significant decrease in the number of days of treatment delay in the intervention group (94 vs. 14 days, p=0.03). The mean number of toxicities identified per patient was 5.3 in the prospective group compared to 1.6 in the retrospective group (p<0.001).

Conclusions

This toxicity management program represented an expanded role for clinical oncology pharmacists. It was well received by patients and considered safe and effective.

Rationale

While there is support for antibiotic stewardship programs in critical care, most data comes from uncontrolled before-and-after studies that are prone to bias and temporal confounding.

Objective

We aimed to rigorously evaluate the impact of a prospective audit-and-feedback program in critical care patients, using a controlled, interrupted time series analysis.

Methods

The antimicrobial stewardship team provided prospective audit-and-feedback for all patients in level III ICUs on their 3rd or 10th day of targeted broad-spectrum antibiotic therapy. Antibiotic use during the one year pilot was compared to the year prior using a controlled interrupted time series analysis. Secondary outcomes included overall antibiotic use, gram negative bacterial susceptibility, rates of nosocomial
C.difficile
infection, length of stay and mortality.

Results

Broad-spectrum antibiotic use significantly decreased (119 DOTs/1000 PDs; SE=37.9; p=0.0054) with the implementation of the program, with no change in either control wards or use of control medications (stress ulcer prophylaxis). The incidence of
C. difficile
infections decreased from 11 to 6 cases, while increasing in the control wards from 87 to 116 cases (p=0.04). Overall gram negative susceptibility to meropenem increased. Length of stay and mortality did not change.

Conclusions

Through collaboration with critical care, a successful prospective audit-and-feedback program was implemented in the level III ICUs.

1
Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON
2
Leslie L. Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
3
Department of Microbiology and Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON
4
Sunnybrook Research Institute, Toronto, ON
5
Faculty of Medicine, University of Toronto, Toronto, ON
6
Public Health Ontario, Toronto, ON
7
Institute for Clinical Evaluative Sciences, Toronto, ON

Background

Medication safety/risk management is a relatively foreign terminology in community pharmacy practice when compared to other health care settings in Canada. This stems from the lack of a medication incident reporting tool tailored for community pharmacies, thereby discouraging community pharmacies from learning past mistakes.

Objective

Based on learning and experience acquired from hospital-based incident reporting, the ISMP Canada Community Pharmacy Incident Reporting (CPhIR) program was created specifically for community/ambulatory pharmacies.

Methods

After multiple iterations of feedback, pilot-testing, and consultation with community pharmacy practitioners, CPhIR is now available to community/ambulatory pharmacies. Reported incidents are analyzed anonymously using a qualitative aggregate analysis approach with key findings disseminated back to frontline users by ISMP Canada.

Results

As of August 2011, there are over 300 registered CPhIR users. An accumulative total of 17,000 incidents have been anonymously reported. CPhIR provides users with a secure online interface to document medication incidents, export data for analysis, and view comparisons of individual pharmacy and aggregate data.

Background

Patients are susceptible to medication errors at the point of transfer, particularly in transfer from an intensive care unit to a general ward. Data to assess the optimal strategy in performing medication reconciliation at the time of transfer is currently limited.

Objectives

To determine if implementation of a medication reconciliation tool comprised of a patient-specific computer generated physician order form would result in a decrease in the number, type and severity of medication discrepancies that occur on internal hospital transfer.

Methods

Two groups of patients transferred from the intensive care unit to the surgery step-down unit were compared. Current practices with regard to transfer orders were provided to the control group and a patient-specific medication reconciliation tool (completed by the transferring physician) was utilized for the intervention group. Medication discrepancies at the time of transfer were identified by two independent reviewers.

Results

Fifty-two patients were included in the analysis. Mean number of discrepancies per-patient were significantly decreased in the intervention group compared to the control group (0.96 ± 1.5 vs. 2.37 ± 1.8; p = 0.003). There was a significant reduction in the number of policy violation discrepancies (0% vs. 45%; p<0.001) and in discrepancy severity (p<0.001) in the intervention group as compared to the control group.

Conclusion

Use of a patient-specific computer generated medication reconciliation tool to ensure that medications are reconciled at the time of transfer is expected to help improve patient safety.

Background

Objectives

Characterize the single dose and steady state pharmacokinetics of oseltamivir and its active carboxylate metabolite in this population.

Methods

The OPTIMO trial was a single center non-randomized open label pharmacokinetic study of single dose and steady state oral oseltamivir phosphate and active metabolite in healthy morbidly obese and healthy, non-obese subjects.

Conclusions

Systemic exposure to oseltamivir is decreased but that of oseltamivir carboxylate is largely unchanged. Based on these pharmacokinetic data, an oseltamivir dose adjustment for body weight would not be needed in morbid obese individuals.

Background

Despite the success of antiretroviral therapy, HIV-infected individuals remain at higher risk of developing malignancies. Clinically important interactions between cART and chemotherapy agents have been described in the literature, but practical, comprehensive guidelines for clinical practice do not exist.

Objective

To provide a comprehensive summary of documented and potential interactions between antiretroviral agents (ARVs), common chemotherapy regimens used in the treatment of lymphoma, and supportive therapy.

Methods

A literature review was conducted through Ovid Medline 1948 – March 2011 using MeSH terms for individual antineoplastics, keywords for chemotherapy regimens, and available and emerging ARVs. Pertinent conference abstracts were identified through the International AIDS Society USA abstract search engine. Quality of evidence was evaluated according to an adapted GRADE system.

Results

Thirteen documents were developed, summarizing potential interactions between ARVs and the following chemotherapy regimens: ABVD, BEACOPP, CHOP, CNS LYMPHOMA, CODOX-M, CVP, DHAP, ESHAP, GDP, ICE, IVAC, MINIBEAM, and supportive therapy. A summary of current principles of HIV treatment was also developed for non-HIV specialists.

Conclusion

This guide provides clinicians with a user-friendly tool which allows quick identification of possible ARV-chemotherapy interactions; clinical implications and practical management guidelines are included to facilitate optimal treatment of both disease states with minimal toxicity.

1
University Health Network, Toronto, ON
2
University of Toronto, Toronto, ON
3
McGill University Health Centre, Montréal, QC

Background

CMedication regimens for solid organ transplant recipients (SOTR) are complex and non-adherence can lead to rejection and graft loss. Educational tools are needed to reinforce patient knowledge of transplant medications.

Objective

To develop a tool to support ongoing medication education needs of SOTR.

Methods

Program content was developed by pharmacists and reviewed by an interprofessional clinician group. Microsoft Power Point®, Adobe® Captivate® and Dreamweaver® were used to create an e-learning internet-based format. A Virtual Patient Focus Group (VPFG) assessed usability and utility of the tool.

Conclusions

While further study is needed, use of an internet-based e-learning program to control content, sequence, pace and timing of education to achieve personal learning objectives appears to be an attractive and effective teaching modality in SOTR.

1
Department of Pharmacy, Toronto General Hospital, University Health Network, Toronto, ON
2
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON